Ahmadov Kamran, Musayev Kamran, Sologashvili Tornike
Department of Cardiovascular Surgery Merkezi Klinika, Baku, Azerbaijan.
Department of Cardiovascular Surgery, Geneva University Hospital, Geneva, Switzerland.
Turk Gogus Kalp Damar Cerrahisi Derg. 2024 Dec 31;32(4 Suppl 2):006-7. doi: 10.5606/tgkdc.dergisi.2024.mob-03. eCollection 2024 Nov.
The study aimed to describe the feasibility and results of a left modified Blalock-Taussig shunt (mBTS) through a sternotomy without opening the pericardium in patients with a right-sided aortic arch.
The study included eight patients (median age: 20 months; range, 10 to 56 months) who underwent a left mBTS. All mBTS procedures were performed through a median sternotomy without the use of cardiopulmonary bypass. Following sternotomy, the brachiocephalic trunk and left pulmonary artery were carefully identified and isolated without opening the pericardium. First, an end-to-side anastomosis was created between the Gore-Tex graft and the brachiocephalic trunk. Subsequently, the distal end-to-side anastomosis was performed between the graft and the left pulmonary artery. A single drain was positioned in the retrosternal space, and the sternum was closed in the standard manner.
Six patients had tetralogy of Fallot, and two had a double-outlet right ventricle with pulmonary stenosis. The median weight was 8 kg (range, 6.1 to 12.8 kg). The procedure was feasible in all patients (Figure 1). The median shunt size was 5 mm (range, 4 to 5 mm), and the median intensive care unit stay was three days. There were no cases of early- or mid-term mortality, shunt failure, or thrombosis. Additionally, no patients developed postoperative pericardial effusion. Six out of eight patients underwent resternotomy for complete correction, with preoperative cardiac catheterization confirming shunt patency (Figure 2). Notably, no intrapericardial adhesions were observed during resternotomy.
This technique offers a significant advantage by avoiding intrapericardial adhesions, making it a viable alternative to standard sternotomy or thoracotomy approaches for mBTS in patients with a right-sided aortic arch.
本研究旨在描述在右位主动脉弓患者中，经胸骨正中切口不打开心包进行左改良布莱洛克 - 陶西格分流术（mBTS）的可行性及结果。
本研究纳入了8例接受左mBTS手术的患者（中位年龄：20个月；范围10至56个月）。所有mBTS手术均通过胸骨正中切口进行，未使用体外循环。胸骨切开后，在不打开心包的情况下仔细识别并分离头臂干和左肺动脉。首先，在戈尔泰克斯移植物与头臂干之间进行端侧吻合。随后，在移植物与左肺动脉之间进行远端端侧吻合。在胸骨后间隙放置一根引流管，按标准方式关闭胸骨。
6例患者为法洛四联症，2例为右心室双出口合并肺动脉狭窄。中位体重为8kg（范围6.1至12.8kg）。该手术在所有患者中均可行（图1）。分流管中位尺寸为5mm（范围4至5mm），中位重症监护病房停留时间为3天。无早期或中期死亡、分流失败或血栓形成的病例。此外，无患者发生术后心包积液。8例患者中有6例接受再次胸骨切开术进行完全矫正，术前心脏导管检查证实分流管通畅（图2）。值得注意的是，再次胸骨切开术期间未观察到心包内粘连。
该技术通过避免心包内粘连具有显著优势，使其成为右位主动脉弓患者mBTS标准胸骨切开术或开胸术方法的可行替代方案。
